When Dr. Sunil Dacha arrived at Houston Methodist in 2018, advanced endoscopy was still in its infancy within the system. Six years later, the program has become one of the most comprehensive and technically sophisticated in the country — offering a breadth and depth of minimally invasive procedures unmatched by few centers.

Today, Houston Methodist’s Advanced Endoscopy Program spans five major domains: pancreaticobiliary endoscopy, luminal endoscopy, third-space endoscopy, bariatric endoscopy and endo-hepatology. Together, these domains enable clinicians to diagnose and treat complex GI conditions — often without surgery, hospitalization or interruption of cancer therapy.

“We’ve transformed advanced endoscopy here. Five or six years ago, none of this was available. Now we can offer patients noninvasive approaches to problems that previously required major surgery.”

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Dr. Sunil Dacha, gastroenterologist

Pancreaticobiliary endoscopy: expanding what’s possible with EUS and ERCP

The program’s core is pancreaticobiliary endoscopy, including high-volume endoscopic retrograde cholangiopancreatography (ERCP) and advanced endoscopic ultrasound (EUS). These procedures support patients with bile duct stones, pancreatic cancer, chronic pancreatitis, cholangiocarcinoma and complex strictures.

Therapeutic EUS has become a defining strength.

Using EUS, Dr. Dacha and his team can biopsy masses, stage cancers, drain obstructed organs and create internal bypasses — all from within the GI tract. “EUS provides a transluminal window,” he explains. “You can see structures through the wall and intervene on adjacent organs.”

Examples include:

• EUS‑guided transgastric ERCP for patients with gastric bypass

• EUS‑guided gallbladder and bile duct drainage

• EUS‑guided gastrojejunostomy to bypass gastric outlet obstruction

• EUS‑guided liver biopsy and portal pressure measurements

These approaches often replace surgeries that would otherwise delay chemotherapy or necessitate external drains. “When we perform these procedures endoscopically, there’s no interruption in chemotherapy,” he says.

Luminal endoscopy: organ‑preserving removal of early cancers and advanced polyps

One of the program’s most impactful areas is luminal endoscopy — particularly the removal of early-stage cancers and large precancerous polyps in the esophagus, stomach and colon.

Cancers of the GI tract typically arise in the mucosa, the first of four layers. When lesions are confined to this layer, they can often be removed endoscopically with endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD).

“If it’s limited to layer one, it’s essentially a curative resection,” Dr. Dacha says. “You don’t need surgery. You take out what’s abnormal and leave the rest intact.”

The alternative — esophagectomy, gastrectomy or colectomy — can be life‑altering.

Patients who undergo esophageal surgery, for example, may never again lie flat or eat normally. “There’s no protective mechanism left to prevent regurgitation,” he explains. “They can’t eat much and must sleep at a high incline for the rest of their lives.”

Endoscopic resection completely avoids these consequences.

Finding more polyps than expected

Houston Methodist’s team has also demonstrated that meticulous technique reveals significantly more pathology than many referring physicians anticipate.

“When we go in to remove a large polyp, we often find many more,” he says. “It shows how many polyps are missed and why there’s an urgent need to improve colonoscopy quality.”

The team has presented these findings at national meetings, underscoring the importance of thorough inspection and advanced training.

Third‑space endoscopy: minimally invasive solutions

Third-space endoscopy — procedures performed within the submucosal “tunnel” of the GI tract — has rapidly expanded treatment options for motility disorders.

Using techniques such as peroral endoscopic myotomy (POEM), gastric peroral endoscopic myotomy (G-POEM) and Zenker’s peroral endoscopic myotomy (Z-POEM), the team can cut dysfunctional muscle fibers without external incisions.

“It’s like tunneling in the oil and gas industry,” Dr. Dacha says. “You enter the second layer, create a tunnel, cut the muscle and close the entry point — all through the mouth.”

Houston is one of the few U.S. cities with multiple centers offering POEM. Nationally, expertise remains limited.

Bariatric endoscopy: a growing frontier

Although Dr. Dacha previously performed bariatric endoscopy, the program is now led by his colleague, Dr. Thomas R. McCarty. In his current role, Dr. McCarty focuses on advanced endoscopic weight-loss interventions, including endoscopic sleeve gastroplasty (ESG) and transoral outlet reduction (TORe), as well as the management of complications related to bariatric surgery. Demand for these services is expected to grow as obesity rates continue to rise.

Endo‑hepatology: minimally invasive options for liver disease

The program also offers a range of advanced EUS-guided interventions, including liver biopsy, treatment of gastric varices and portal pressure measurement. Together, these procedures can reduce the need for transjugular approaches while expanding care options for patients with cirrhosis or portal hypertension.

A referral center for the region and beyond

Houston Methodist now receives referrals not only from community gastroenterologists but also from thoracic surgeons, colorectal surgeons, surgical oncologists and medical oncologists.

“Surgeons are among our biggest referrers,” Dr. Dacha says. “They’ve seen what we can do, and they send patients to us rather than going straight to surgery.”

Still, he notes that awareness remains a challenge.

“Unfortunately, a lot of benign polyps still go to surgery,” he says. “There’s a lack of awareness. Even GI doctors sometimes send patients to surgeons who may not know these options exist.”

His message to colleagues is simple: “Keep yourself abreast of evolving techniques. Endoscopy is changing every year. Just ask for help — there are people who can take care of these lesions.”

Why advanced endoscopy is accelerating now

Several forces are driving rapid growth in the field. Advances in new devices and technologies are expanding what is possible, while an increasing number of trainees are seeking to develop advanced skills. At the same time, global knowledge sharing through social media is accelerating the spread of techniques and insights. Compounding these trends is the rising incidence of early-onset gastrointestinal cancers, particularly among young women, which is spurring demand and innovation in the field.

“Technology is a big enabler,” he says. “Ten years ago, we didn’t have these tools. And social media has connected endoscopists worldwide. You can see what people are doing in Asia or the Middle East and learn from it.”

A passion for organ preservation

For Dr. Dacha, the work is deeply personal.

“This is a passion of mine,” he says. “We’re saving organs, avoiding life‑altering surgeries and giving patients options they didn’t have before.”

As the program grows, Houston Methodist is set to maintain its position as a national leader in advanced endoscopy, providing patients with innovative, minimally invasive treatments that enhance quality of life and speed up recovery.